Provider Demographics
NPI:1265465157
Name:KILAMBI, NAVIN R (MD)
Entity type:Individual
Prefix:
First Name:NAVIN
Middle Name:R
Last Name:KILAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W VAN ASCHE LOOP
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4996
Mailing Address - Country:US
Mailing Address - Phone:479-966-4491
Mailing Address - Fax:479-996-4311
Practice Address - Street 1:201 W VAN ASCHE LOOP
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4996
Practice Address - Country:US
Practice Address - Phone:479-966-4491
Practice Address - Fax:479-996-4311
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35400207X00000X
OK32000207XX0005X
ARE-13056207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0334580001OtherDMERC
OK200626820AMedicaid
KY00546040Medicare Oscar/Certification
KYP00605813Medicare PIN
OK476365YPF1Medicare PIN